Monthly Archives: March 2016

On March 2, 2016, Dr. G Kevin Donovan testified at the “Bioethics and Fetal Tissue” hearing before the Select Investigative Panel of the Committee on Energy and Commerce of the US House of Representatives. Dr. Donovan was one of six witnesses to present testimony.

Chairman Blackburn, and members of the panel, I thank you for the opportunity to present testimony regarding the bioethical considerations in the harvesting, transfer, and use of fetal tissues and organs.

I am a physician trained in both pediatrics and clinical bioethics. I have spent my entire professional career caring for infants and children. It was this interest and concern that led me to further study in bioethics, because I have always been concerned about the most vulnerable patients, those who need others to speak up for them, both at the beginning and at the end-of-life. I also have significant familiarity with research ethics, having spent 17 years as the chair of the IRB, a board that monitors the rightness and the wrongness of medical research in order to protect human subjects. We took this aspect of our duties so seriously that I renamed our IRB the Institutional Research Ethics Board. Four years ago, I was called by my mentor, Dr. Edmund Pellegrino, to take his place as director of the Center for Clinical Bioethics at Georgetown University. Our duties include ethics education for medical students and resident physicians, ethics consultation for patients and doctors at the hospital, as well as the promulgation of scholarly papers and public speaking. We focus on both clinical ethics, that which directly involves the good of patients, as well as addressing normative questions, those which involve right and wrong actions.

This is what we want young physicians to know: medicine is a moral enterprise. Our actions have consequences that can be good or bad for patients, and we must always focus on the patient’s good and avoid doing harm. So what does this mean for the topic at hand? We’re talking about bioethics and the fetus. In order to make any moral judgments, we would have to be clear on the moral status of the fetus. Obviously, this is an area in which society has not reached a consensus, but that does not mean we cannot make sound judgments on the topic. In a question of biomedical ethics, it is good to start with solid science. What do we know about the fetus with certainty? Well, first of all we know that it is alive, that it represents growing, developing, cells, tissues, and organs, all of which develop increasing complexity and biologic sophistication, resulting in an intact organism, a human baby. Of course, this growth and development does not cease with the production of the baby, but continues for many years afterwards. As can be seen by this description, the fetus is not only alive, but is demonstrably human. I’m not talking about a “potential human” in the way that some parents talk about their teenagers as potential adults. I am referring to the scientific fact that a fetus constitutes a live human, typically 46XX or 46XY, fully and genetically human. In fact, it is the irrefutable humanness of these tissues and organs that have made them be of interest to researchers and scientists.

So, if a fetus is clearly both alive and human, can we justify taking these tissues and organs for scientific experimentation? If so, under what circumstances, and what sort of consent or authorization should be required? In the past century, medicine has made incredible progress resulting from scientific studies involving human tissues and organs, resulting in the development of medications, vaccines, and the entire field of transplantation medicine. Is there any difference between these accomplishments and those that would require the harvesting of bod parts and tissues from the fetus? First, we would have to admit that not all scientific experimentation has been praiseworthy. Studies done by Dr. Mengele in Germany, and by American researchers in Guatemala and Tuskegee, we morally abhorrent, and any knowledge gleaned from these would be severely tainted. No one would want to associate our current scientific studies involving the human fetus with such egregious breaches of research ethics. All that it takes to avoid such a comparison is a consensus on the moral status of the fetus.

Those who have proceeded with experimentation and research on embryonic and fetal cells, tissues, and organs typically have obtained them as the result of an abortion. It is this stark fact that makes such scientific endeavors controversial, because they have proceeded without the aforementioned consensus on the moral status of the fetus. Because we know that the fetus is alive, and human, we must find some explanation for why it should not be treated with the same dignity that we accord all other human lives. The most frequent argument offered is that, although it is a human life, it is not a human person. Various criteria are offered for a definition of personhood, but none have been found universally acceptable. We thus have a standoff between those who would protect this early vulnerable human life and those that would deny that it deserves protection. In order to resolve such an ethical dilemma, the guiding principle is this: one is morally permitted to take such a life once you can demonstrate with moral certainty that the life is not human. It is a concept that can be exemplified by the situation faced by a hunter when he sees a bush shaking. He may sincerely believe that it is a deer in the bush, but if he kills it prior to determining with certainty what it is that he is killing, he will be morally responsible (as well as legally) if he has in fact killed the farmer’s cow, or worse yet, the farmer. As we can see, two deeply held, but opposing viewpoints need not be resolved unless someone intends to act upon them. Then, the one who intends to take the action resulting in the death of the disputed entity must not do so unless they can first show with moral certainty that their perception of its moral worth is irrefutable. Those who would not disturb the normal progression of its life bear no such burden. It’s my contention that such proof does not exist, and deliberate fetal destruction for scientific purposes should not proceed until it does.

Moreover, without disputing the arguable necessity of research on fetal tissue, I would also point out that harvesting it n such a way is unnecessary. Not only do cell lines already exist that were produced in such a fashion, but new cell lines could be obtained from fetal tissues harvested from spontaneous miscarriages. This is not a theoretical alternative. Georgetown University has a professor who has patented a method of isolating, processing, and cryopreserving fetal cells from second trimester (16-20 week gestation) miscarriages. These have already been obtained and are stored in Georgetown freezers.

Moreover, the present practices of obtaining fetal tissues and organs would seem to go against the procedures that have been approved for others who harvest tissues and organs donated for transplantation. First, we follow a strict rule, the dead donor rule. It states that vital unpaired organs cannot be obtained unless the donor has died a natural death. This obviously is not the case in an induced abortion. Moreover, such tissues or organs cannot be harvested without consent of the patient or their proper surrogate. In pediatrics, parents are considered the normal proper surrogate. However, this interpretation rests on the presumption that the parent is acting in the best interests of the individual. It is difficult to sustain such an interpretation when it is the same parent who has just consented to the abortive destruction of the individual from whom those tissues and organs would be obtained.

We are at a difficult time in our nation’s history. We demonstrate much moral ambiguity in our approach to the human fetus. We have decided that we can legally abort the same fetus that might otherwise be a candidate for fetal surgery, even using the same indications as justification for acts that are diametrically opposed. We call it the fetus if it is to be aborted and its tissues and organs transferred to a scientific lab. We call it a baby, even at the same stage of gestation, when someone plans to keep it and bring it into their home. Language has consequences, but it can also reflect our conflicts. We are a nation justly proud of the progress and achievements of our biomedical research, but lifesaving research cannot and should not require the destruction of life for it to go forward. If we cannot act with moral certainty regarding the appropriate respect and dignity of the fetus, we cannot morally justify its destruction. Alternatives clearly exist that are less controversial, and moral arguments exist that support our natural abhorrence at the trafficking of human fetal parts. Surely we can, and surely we must, find a better way.

Written testimony from Dr. G Kevin Donovan at a joint hearing of the House Health & Government Operations Committee and the Judiciary Committee of Maryland on February 19, 2016, regarding the proposed end-of-life bill.

Thank you for the opportunity to address this proposed legislation. I am Dr. Kevin Donovan, a physician, and the director of the Pellegrino Center for Clinical Bioethics at Georgetown University Medical School. Much of my work in the hospital setting involves consultation on patients who are nearing the end of their lives, so I have a real interest in this bill.

You will hear from others about the problems that have arisen in identical bills. You will hear about the dangers it can cause to patients, particularly the disabled or chronically ill, to the medical profession, and society at large. So I will not tell you about these things. I will tell you that I oppose this bill for two reasons: it is discriminatory, not progressive, but itis deceitful.

Okay, what are we talking about? Aren’t progressive people in favor of this bill? Perhaps some are, but if they look deeply into it, they shouldn’t be. Years ago, Sen. Hubert Humphrey said the real worth of any society can be found in the way that it cares for its most vulnerable members. That would be progressive, but we live in a society that increasingly worships autonomy, freedom, and productivity, and pushes those that don’t fit the picture to the margins. Therefore, it should come as no surprise that marginalized people, the poor, blacks, Latinos, and virtually every disability rights group are afraid of this bill. It creates by law a class of people whose lives no longer should be preserved. Of course, creating separate classes of people is discriminatory, but isn’t that what the supporters of this bill want? Yes, and we should look and see who are the supporters of this bill. It is favored by the same classes of people that have taken advantage of it in places like Oregon. Who’s the typical proponent, and patient? As published statistics show, the typical patient is a white male, usually with cancer, educated and financially comfortable. This is someone who is used to thinking that they are in control, and want to maintain the illusion of control near the end their lives. And make no mistake – the data from the Oregon health department makes it clear that this is not an issue of avoiding pain. The stated reasons for seeking a fatal prescription are primarily loss of autonomy, loss of ability to engage in enjoyable activities, or fear of being a burden to others. Pain is low on the list, because with good palliative care, pain is controllable. We’ve just described legislation that would favor the white elite, not the sort of thing that progressives usually want to get behind. And as one commentator asked, “Is anyone ashamed that we live in a culture where people believe that if they aren’t autonomous, or might be a burden on others, that they should ingest drugs and die?” I would think that Maryland should be ashamed of promoting assisted suicide for patients before palliative care is universally available?

Okay, if this bill is discriminatory not progressive, why should it be seen as deceitful? First of all, our antenna should always go up when people start using euphemisms. What started out as a movement for physician assisted suicide became physician assisted death, and now just wants to be thought of as death with dignity. Really? This can’t be the only path to dignity, and it clearly is suicide that we’re talking about. After all, the Center for Disease Control defines suicide as, and I quote “Death caused by self-directed injurious behavior with an intent to die.” What we’re talking about in this bill is clearly suicide, whether or not we’re allowed to put that on the death certificate, and by the way suicide is already legal. And when we talk about the protections in this bill, we’re not being entirely forthright either. The ones who are really being protected are the physicians, once again, members of the power elite. We may say we are placing restrictions for the patients involved, but that’s not entirely true, because they’re not entirely coherent. After all, once we redefine supporting or encouraging a patient’s death as a good thing, how can we defend limiting that benefit, that good thing, to only those who will be dead in six months? Why not 12 months? Why only terminal illness – why not suffering from chronic disease? Why only assisted suicide? What if the patient can’t lift the toxic mixture to their lips – shouldn’t someone else be able to give them a lethal dose? Shouldn’t we be willing to end the suffering in this way, even if you’re under 18, even if you’re only a child? Proponents will say that this is not what the bill says, nor what they intend, but this is the natural, logical, and really inevitable result of this redefinition of death as a medical treatment. In fact, this has already happened in Belgium and the Netherlands, countries that have been doing this longer than we have.

Finally, this brings us to an area which make legislators truly sit up and take notice: it is just not good public policy. Suggesting that suicide or euthanasia, are legitimate tools of the state is frightening. Throughout history, we have learned that granting the state legal authority to kill innocent individuals has had dreadful consequences. In Maryland, if you are convicted murderer and in no way innocent, you would be protected from the killing power of the state. Why would we want to turn that power to kill on our patients with their physicians help? A Dutch cardiologist, who has experience with this in his own country, recently stated, “the fundamental question about this is whether it is a libertarian movement for human freedom and the right of choice, or an aggressive drive to exterminate the weak, the old, and the different – this question can now be answered. It is both.“ I have no doubt that some patients with great independence will choose an early death at the end of their lives. They should not be judged, they should never be prosecuted for the attempt. As a society, we should be offering patients loving support until the very end. We shouldn’t change the law in a way that might encourage their deaths, we shouldn’t take their hands and lead them towards that, and certainly shouldn’t make them feel that they are being subtly pushed into it. The sick, the vulnerable, the suffering and dying deserve so much better, and a truly caring society will provide them with no less.

Addendum:

” On March 4, the bill SB 418 was withdrawn by its sponsor Senator Ron Young for lack of supporting votes, killing it for the legislative year.”